Neurology

Question 1

Patient presents with a 3 week history of severe eye pain, watering and a stuffy nose 3 times a day every day. What is the most likely diagnosis?

Answer 1

Cluster headache

Question 2

How do you treat cluster headaches?

Answer 2

Sumitriptan

Question 3

What MUST be ruled out in a patient with a painful 3rd nerve palsy?

Answer 3

Posterior communicating artery aneurysm

Question 4

A 28 year old lady with epilepsy comes to see the gp as she is hoping to fall pregnant. What supplement advice must she be given?

Answer 4

Folic acid 5mg/day from as soon as you start trying to get pregnant

Question 5

Epileptic women has been taking phenytoin throughout her pregnancy due to poor seizure control. What must be taken in the last month of pregnancy?

Answer 5

Vitamin K

Question 6

How would you initially treat status epilepticus in hospital?

Answer 6

4mg IV lorazepam

Question 7

How is established status epilepticus treated?

Answer 7

IV phenytoin or valproate

Question 8

Which 2 drugs can be used for migraine prophylaxis?

Answer 8

Topiramate or propanolol

Question 9

What drug is given in a patient with a sub arachnoid haemorrhage to reduce the chance of complications?

Answer 9

Nimodipine

Question 10

Which anti emetic can be prescribed in a patient with Parkinson’s?

Answer 10

Domperidone

Question 11

What is the first line treatment for a teenage boy with JME (Juvenile myoclonic epilepsy)?

Answer 11

Sodium valproate

Question 12

What is the first line treatment for a teenage girl with JME (Juvenile myoclonic epilepsy)?

Answer 12

Leviteracetam or lamotrigine

Question 13

What is the first line treatment for focal or partial epilepsy?

Answer 13

Carbamazepine

Question 14

What kind of seizure often presents with aura, e.g. a change in smell or taste?

Answer 14

Temporal lobe epilepsy (complex partial)

Question 15

A 24-year-old man with complex partial seizures - what drug is used to treat?

Answer 15

Carbamazepine

Question 16

First-line anti-epileptic in a 17-year-old girl with tonic-clonic seizures. She is not sexually active but uses the combined oral contraceptive pill to control her periods

Answer 16

Lamotrigine

Question 17

You review a 24 year old woman in the high dependency unit. She is moaning but unable to form words, and appears to open her eyes when you speak to her. She is unable to follow commands, but withdraws to pain. What is her GCS?

Answer 17

9
M - 4
V - 2
E - 3

Question 18

What are the features of a third nerve palsy?

Answer 18

• eye is deviated ‘down and out’
• ptosis
• pupil may be dilated

Question 19

Following recent NICE guidelines, which of the following medications should he be taking upon discharge of an ischaemic stroke, which was treated with aspirin in hospital (i.e. after 14 days)?

Answer 19

Clopidogrel and a statin

Question 20

A 25-year-old female is found to have a left hemiparesis following a deep vein thrombosis. What is the most likely cause? Explain

Answer 20

Ostium secundum atrial septal defect
The ostium secundum in this patient has allowed passage of an embolus from the right-sided circulation to the left causing a stroke

Question 21

What is first line therapy for spasticity in patients with MS?

Answer 21

Baclofen or gabapentin